[Safety of nicotine addiction treatment]

Not all smoking addicts can succeed in quitting smoking with willpower only. These people may use nicotine replacement therapy (patches, gums, lozenges, sublingual tablets, inhalers), medicines (bupropion, varenicline and cytisine) and psychological aid. Each drug, besides its therapeutic effect, creates the risk of adverse reactions which number and severity is not always accepted by the patient. The aim of the study was to analyze adverse effects of bupropion, varenicline and cytisine formulations reported by patients. From July 2011 to June 2013 Regional Centre for Monitoring Adverse Drug Reactions (Department of Clinical Pharmacology, Department of Cardiology, Poznan University of Medical Sciences) recorded 32 suspected adverse reactions to the use of drugs for the treatment of nicotine addiction (12 after the preparation of cytisine and varenicline, 8 after preparations of bupropion). High determination caused that none of the patients withdrew from the therapy because of adverse effects.

Influence of saponins and tannins on intake and nutrient digestion of alkaloid-containing foods

BACKGROUND

We hypothesized that eating a food containing saponins (SAP), or tannins (TAN) prior to foods containing the alkaloids gramine (GRA) or 5-methoxy-N,N-dimethyltryptamine (TRP) would provide benefits not possible when the alkaloid-containing foods were eaten alone.

METHODS

In Trial 1, four groups of five lambs were first offered food with SAP for 30 min followed by food with either GRA or TRP for 3.5 h in a 2 × 2 factorial arrangement of a completely randomized design that included alkaloid (GRA or TRP) with or without SAP. In Trial 2 TAN replaced SAP. All foods were isocaloric (3.3 Mcal kg⁻¹) and isonitrogenous (14% crude protein). Foods, fecal and urine samples were collected and analyzed for dry matter intake and apparent digestibility of dry matter, energy (in megajoules, MJ), nitrogen (N), and neutral detergent fiber.

RESULTS

Supplemental SAP did not affect digestibility of the parameters tested (P > 0.10). Supplemental TAN increased digestibility of N (g kg⁻¹, P = 0.04), N retained (g day⁻¹, P = 0.07), N digested (g day⁻¹, P = 0.06), and N retained/N consumed (g kg⁻¹, P = 0.07). However, digestibilities of dry matter (g kg⁻¹, P = 0.0026), energy (MJ 1000 MJ⁻¹, P = 0.003), neutral detergent fiber (g kg⁻¹, P = 0.008), and digested N retained (g kg⁻¹, P = 0.07) were lower for lambs fed TAN than for unsupplemented animals.

CONCLUSIONS

Tannin supplementation can improve retention of nitrogen in animals fed alkaloid-containing grasses such as reed canarygrass and tall fescue. Combinations of forages with complementary primary and secondary compounds enable animals to maintain intake and improve nutrient utilization.

Cytotoxic and anti-HIV phenanthroindolizidine alkaloids from Cryptocarya chinensis

Bioassay-guided fractionation of the cytotoxic ethanol extract of Cryptocarya chinensis has led to the isolation of 11 compounds, including two phenanthroindolizidine alkaloids [(-)-antofine (1) and dehydroantofine (2)], five pavine alkaloids (3-7), and four proaporphine alkaloids (8-11). The structures of the isolated compounds were determined by means of NMR spectroscopic methods, and supported by HRMS and optical rotation data. Compounds 1 and 2 showed cytotoxic activity against four cancer cell lines, L1210, P388, A549, and HCT-8, with 1 being the most potent against A549 and HCT-8 with EC50 values of 0.002 and 0.001 microg/mL, respectively. In addition, 2 is first reported to exhibit significant anti-HIV activity.

Supplementing endophyte-infected tall fescue or reed canarygrass with alfalfa or birdsfoot trefoil increases forage intake and digestibility by sheep

BACKGROUND

We hypothesized that alfalfa (ALF) or birdsfoot trefoil (BFT) eaten prior to a meal of endophyte-infected tall fescue (TF) or reed canarygrass (RCG) would provide benefits not possible when TF or RCG are eaten alone. In trial 1, four groups of five lambs were first offered ALF for 30 min followed by either TF or RCG for 3.5 h in a 2 × 2 factorial arrangement of a completely randomized design that included grass (TF or RCG) with or without ALF. Trial 2 was similar to trial 1 except we used a new group of lambs fed BFT. Forage, fecal and urine samples were collected and analyzed for dry matter intake and apparent digestibility of dry matter, energy (in Kcal), nitrogen and neutral detergent fiber.

RESULTS

A meal of either ALF or BFT prior to eating TF or RCG caused lambs to eat more total dry matter and nitrogen (both in g d⁻¹) and energy (in MJ d⁻¹) than lambs fed only TF or RCG (P < 0.05). Lambs fed ALF slightly reduced intake of TF and RCG relative to unsupplemented animals. Lambs fed BFT ate slightly less RCG, but much more TF than unsupplemented animals (P < 0.10). Lambs ate much less BFT than ALF, but they were stimulated to eat TF to a greater degree by BFT than by ALF.

CONCLUSIONS

The enhanced intake of TF by lambs provided BFT, as well as the greater nutrient intake by lambs fed legumes and grasses was likely due in part to complementary profiles of alkaloids, saponins, and tannins.

Validation of self-reported khat chewing amongst khat chewers: an exploratory study

ETHNOPHARMACOLOGICAL RELEVANCE

Khat chewing amongst the UK communities originating from Yemen and the East African coast is suggested to create dependency through its main stimulant components (cathinone, norephedrine and norpseudoephedrine) on the central nervous system.

AIMS OF THE STUDY

To validate self-reported khat chewing behaviours by measuring levels of cathinone, norephedrine and norpseudoephedrine in saliva and to explore their associations with self-reported khat chewing dependency.

MATERIALS AND METHODS

Face-to-face interviews were conducted amongst 30 male UK-resident khat chewers. Saliva samples were collected from each participant and high-performance liquid chromatography (HPLC) employed to extract and quantify the levels of the biomarkers.

RESULTS

The mean (SD) for cathinone and the composite norephedrine and norpseudoephedrine levels were 33.93 (±39.20) and 29.28 (±26.32)μg/mL respectively. These biomarkers were significantly associated (p≤0.05) with khat chewing dependency.

CONCLUSIONS

Validation of self-reported khat chewing is possible. Khat chewing dependency correlates significantly with biomarker levels in saliva. Replication is required.

Designer Drug (DD) abuse in Poland; a review of the psychoactive and toxic properties of substances found from seizures of illegal drug products and the legal consequences thereof. Part 1--cannabinoids and cathinones

Faced with the rapidly growing increase of designer drug abuse, particularly amongst the younger generation, various legislative strategies are currently employed world-wide for tackling this problem - however with mixed results. The key issue is that the producers of DDs are able to either exploit existing legal substances intended for other uses, but which have been found to possess psychoactive properties, or to synthesise new psychoactive substances by introducing chemical modifications, often very minor ones, thereby avoiding the prohibited use of chemicals included on any banned lists. Some countries opt to ban new drugs as and when shown or considered to be harmful, while others introduce sweeping bans based on chemical structure. Nevertheless, an ever increasing diversity of new DDs are constantly appearing on domestic and Internet markets. Poland, together with the UK and Eire, has placed temporary bans on all DDs whenever they have been identified, thus enabling sufficient time for assessing their potential hazards to health. Part of this 'holding' strategy entails a thorough review of the scientific literature, including expert opinion when direct evidence is lacking, as well as information received from EU support organisations Europol and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). This paper, in two parts, therefore aims to provide an up-to-date summary review of available scientific evidence on the harm caused by the six main chemical groupings of DDs found in drug seizures of illegal products recently made in Poland. The first part is devoted to Cannabinoids and Cathinones derivatives. Ensuing legislation can therefore be rapidly formulated to make the bans permanent as appropriate.

The untold truth about "bath salt" highs: A case series demonstrating local tissue injury

The epidemic of injecting cathinone derivatives, marketed as "bath salts", by intravenous drug users among inner city Dubliners led to an associated rise in soft tissue complications. The spectrum of the cases encountered, ranging from self-limiting cellulitis to extensive abscess formation, at a single institution is described.

Schedules of controlled substances: temporary placement of three synthetic cathinones in Schedule I. Final Order

The Administrator of the Drug Enforcement Administration (DEA) is issuing this final order to temporarily schedule three synthetic cathinones under the Controlled Substances Act (CSA) pursuant to the temporary scheduling provisions of 21 U.S.C. 811(h). The substances are 4-methyl-N-methylcathinone (mephedrone), 3,4-methylenedioxy-N-methylcathinone (methylone), and 3,4-methylenedioxypyrovalerone (MDPV). This action is based on a finding by the Administrator that the placement of these synthetic cathinones and their salts, isomers, and salts of isomers into Schedule I of the CSA is necessary to avoid an imminent hazard to the public safety. As a result of this order, the full effect of the CSA and its implementing regulations including criminal, civil and administrative penalties, sanctions and regulatory controls of Schedule I substances will be imposed on the manufacture, distribution, possession, importation, and exportation of these synthetic cathinones.

Anti-inflammatory activity of alkaloids: an update from 2000 to 2010

Many natural substances with proven anti-inflammatory activity have been isolated throughout the years. The aim of this review is to review naturally sourced alkaloids with anti-inflammatory effects reported from 2000 to 2010. The assays were conducted mostly in vivo, and carrageenan-induced pedal edema was the most used experimental model. Of the 49 alkaloids evaluated, 40 demonstrated anti-inflammatory activity. Of these the most studied type were the isoquinolines. This review was based on NAPRALERT data bank, Web of Science and Chemical Abstracts. In this review, 95 references are cited.

Khat use and neurobehavioral functions: suggestions for future studies

Although there is a rich body of research available regarding the effect of acute and chronic khat dosing in animal models, research on the behavioral and cognitive effects of khat in human subjects is not extensive and several of the available studies have been done only in the context of observational and single-case studies. In light of the absence of a substantial literature on the neurobehavioral deficits associated with khat use and to provide a context that could be used to identify themes for future research we review previous research that has focused on other stimulant drugs. This review highlights multiple areas of neurocognitive deficit that have been identified in previous studies of individuals who have been chronic users of stimulants, such as amphetamines and methamphetamines. The review highlights a substantial body of evidence demonstrating a wide range of learning and memory impairments including deficits that persist during abstinence from active drug use. This review does not imply a similar khat effect, but due to some similarities pharmacologically between the active components of khat (cathinone and cathine) and amphetamines, future studies examining these same domains of cognitive functioning in chronic khat users and abstinent khat users appears to be warranted, if possible using some of the same or similar laboratory measures.

Khat chewing, cardiovascular diseases and other internal medical problems: the current situation and directions for future research

The leaves of khat (Catha edulis Forsk.) are chewed as a social habit for the central stimulant action of their cathinone content. This review summarizes the prevalence of the habit worldwide, the actions, uses, constituents and adverse health effects of khat chewing. There is growing concern about the health hazards of chronic khat chewing and this review concentrates on the adverse effects on health in the peripheral systems of the body, including the cardiovascular system and gastrointestinal tract. Comparisons are made with amphetamine and ecstasy in particular on the detrimental effects on the cardiovascular system. The underlying mechanisms of action of khat and its main constituent, cathinone, on the cardiovascular system are discussed. Links have been proposed between khat chewing and the incidence of myocardial infarction, dilated cardiomyopathy, vascular disease such as hypertension, cerebrovascular ischaemia and thromboembolism, diabetes, sexual dysfunction, duodenal ulcer and hepatitis. The evidence, however, is often based on limited numbers of case reports and only few prospective controlled studies have been undertaken. There is therefore an urgent need for more thorough case-control studies to be performed. This review outlines the current knowledge on the adverse health effects of khat chewing on the cardiovascular system and other internal medical problems, it assesses the evidence and the limitations of the studies and identifies the questions that future studies should address.

Association of khat chewing with increased risk of stroke and death in patients presenting with acute coronary syndrome

OBJECTIVE

To evaluate the prevalence and significance of khat chewing in patients with acute coronary syndrome (ACS).

PATIENTS AND METHODS

From January 29, 2007, through July 29, 2007, 8176 consecutive patients presenting with ACS were enrolled in a prospective, multicenter study from 6 adjacent Middle Eastern countries.

RESULTS

Of the 8176 study patients, 7242 (88.6%) were non-khat chewers, and 934 (11.4%) were khat chewers, mainly of Yemeni origin. Khat chewers were older (57 vs 56 years; P=.01) and more likely to be men (85.7% vs 74.5%) compared with non-khat chewers. Non-khat chewers were more likely to have diabetes mellitus, hypertension, dyslipidemia, obesity, and prior history of coronary artery disease and revascularization. Cigarette smoking was more prevalent in khat chewers, and they were more likely to present greater than 12 hours after onset of symptoms compared with non-khat chewers. At admission, khat chewers had higher heart rate, Killip class, and Global Registry of Acute Coronary Events risk scores. Khat chewers had a significantly higher risk of cardiogenic shock, stroke, and mortality. After adjustment of baseline variables, khat chewing was an independent risk factor for in-hospital mortality (odds ratio, 1.9; 95% confidence interval, 1.3-2.7; P<.001) and stroke (odds ratio, 2.7; 95% confidence interval, 1.3-5.9; P=.01).

CONCLUSION

In this large cohort of patients with ACS, khat chewing was prevalent and was associated with increased risk of stroke and death. In the context of increasing global migration, a greater awareness of potential widespread practices is essential.

Evaluation of the cytotoxic effect of the monoterpene indole alkaloid echitamine in-vitro and in tumour-bearing mice

The cytotoxic effect of various concentrations of echitamine chloride was studied in HeLa, HepG2, HL60, KB and MCF-7 cell lines in-vitro and in mice bearing Ehrlich ascites carcinoma (EAC). Exposure of various cells to different concentrations of echitamine chloride resulted in a concentration-dependent cell killing, and KB cells were found to be most sensitive amongst all the cells evaluated. EAC mice treated with 1, 2, 4, 6, 8, 12 or 16 mgkg−1 echitamine chloride showed a dose-dependent elevation in the anti-tumour activity, as evident by increased number of survivors in comparison with the non-drug treated controls. The highest dose of echitamine chloride (16 mg kg−1) caused toxicity in the recipient mice, therefore 12 mg kg−1 was considered the best cytotoxic dose for its anti-tumour effect. Administration of 12 mg kg−1 echitamine chloride resulted in an increase in the median survival time (MST) up to 30.5 days, which was 11.5 days higher than the non-drug treated control (19 days). Administration of 16 mg kg−1 echitamine chloride to EAC mice resulted in a time dependent elevation in lipid peroxidation that reached a peak at 6 h post-treatment, whereas glutathione concentration declined in a time dependent manner and a maximum decline was reported at 3 h post-treatment. Our study demonstrated that echitamine chloride possessed anti-tumour activity in-vitro and in-vivo.

Bioactive azafluorenone alkaloids from Polyalthia debilis (Pierre) Finet & Gagnep

This study investigated bioactive extracts of Polyalthia debilis (Annonaceae) with antimicrobial, antimalarial and cytotoxic activities. Extensive chromatographic isolations provided azafluorenone alkaloids; onychine (1) and 7-methoxyonychine (2) together with a mixture of β–sitosterol and stigmasterol. The two alkaloids were isolated from the P. debilis for the first time. Isolated fractions containing a mixture of triterpenoids (C7, C8 and C9) exhibited the most potent antimicrobial activity against many bacterial strains with minimum inhibitory concentration of 64 μg/mL. Fractions with antimalarial and cytotoxic activities were also observed. The findings suggest the potential use of P. debilis in medicinal applications.

Aconitum in traditional Chinese medicine: a valuable drug or an unpredictable risk?

Aconitum species have been used in China as an essential drug in Traditional Chinese Medicine (TCM) for 2000 years. Reviewing the clinical application of Aconitum, their pharmacological effects, toxicity and detoxifying measures, herb-herb interactions, clinical taboos, famous herbal formulas, traditional and current herbal processing methods based upon a wide range of literature investigations serve as a case study to explore the multidisciplinary implications of botanicals used in TCM. The toxicological risk of improper usage of Aconitum remains very high, especially in countries like China, India and Japan. The toxicity of Aconitum mainly derives from the diester diterpene alkaloids (DDAs) including aconitine (AC), mesaconitine (MA) and hypaconitine (HA). They can be decomposed into less or non-toxic derivatives through Chinese traditional processing methods (Paozhi), which play an essential role in detoxification. Using Paozhi, the three main forms of processed aconite -- yanfuzi, heishunpian and baifupian -- can be obtained (CPCommission, 2005). Moreover, some new processing techniques have been developed in China such as pressure-steaming. The current development of fingerprint assays, in particular HPLC, has set a good basis to conduct an appropriate quality control for TCM crude herbs and their ready-made products. Therefore, a stipulation for a maximum level of DDA content of Aconitum is highly desirable in order to guarantee the clinical safety and its low toxicity in decoctions. Newly developed HPLC methods have made the accurate and simultaneous determination and quantification of DDA content interesting.

Cytisine for smoking cessation: a research agenda

Cytisine has a molecular structure somewhat similar to that of nicotine and varenicline. The concept for the new smoking cessation drug varenicline was based partly on cytisine. Like varenicline, cytisine is a partial agonist of nicotinic acetylcholine receptors, with high affinity for alpha4beta2 receptors. Cytisine has been used since the 1960s as a smoking cessation drug in Eastern and Central Europe, but has remained largely unnoticed elsewhere. Three placebo-controlled trials, conducted in East and West Germany in the 1960s and 1970s, suggest that cytisine, even with minimal behavioural support, may be effective in aiding smoking cessation. Cytisine tablets are very inexpensive to produce and could be a more affordable treatment than nicotine replacement, bupropion and varenicline. There is however a dearth of scientific research on the properties of cytisine, including safety, abuse liability and efficacy. This paper seeks to identify research priorities for molecular, animal and clinical studies. In particular, new studies are necessary to define the nicotinic receptor interaction profile of cytisine, to establish its pharmacokinetics and pharmacodynamics in humans, to determine whether animals self-administer cytisine, and to ascertain whether cytisine is safe and effective as a smoking cessation drug. Potentially, this research effort, contributing to wider use of an inexpensive drug, could save many lives.

[Banned performance enhancing ergogenic aids in children and adolescent athletes]

Ergogenic aids (from the Greek, ergon, meaning work) are ingested to enhance energy utilization in athletes. In recent years there has been an increase in youth participating in competitive sports and, as a consequence, a concomitant increase in the usage of performance enhancing substances. Ergogenic aid usage could influence, or its efficiency could be influenced, during this period of rapid growth and sexual maturation, and by the marked hormonal fluctuations. Ephedra alkaloids; pain relief medications, diuretics, anabolic steroids and protein hormones are among the ergogenic aids used by young athletes. While there is no scientific evidence to support the usage of these agents for enhancing performance in children and adolescents, using supra-physiological doses may be associated with undesired side effects.

PKC blockade differentially affects aversive but not appetitive gustatory memories

After consumption of a new taste, there are mainly two possible outcomes for the establishment of a taste memory, either it will be aversive or safe depending on the consequences of taste consumption. It has been proposed that both types of learning share a common initial taste memory trace, which will lead to two different memory traces, safe or aversive. To study the role of PKC activity in aversive or safe taste memory formation, we administered chelerythrine, a PKC inhibitor, into the insular cortex or parietal cortex 20 min before conditioned taste aversion or attenuation of neophobia training. The results suggest that PKC activity is needed in the insular cortex for the establishment of aversive taste memory, but not for safe taste memory.

Khat (Catha edulis): health aspects of khat chewing

Catha edulis Forsk leaves (khat) are chewed daily by a high proportion of the adult population in Yemen for the mild stimulant effect. Cathinone is believed to be the main active ingredient in fresh khat leaves and is structurally related and pharmacologically similar to amphetamine. The habit of khat chewing is widespread with a deep-rooted sociocultural tradition in Yemen and as such poses a public health problem. The objective of this literature review was to examine studies on khat, particularly human studies, with special reference to its effect on the central nervous system, cardiovascular, digestive and genitourinary systems, oral-dental tissues, diabetes mellitus and cancer.

An uncontrolled trial of cytisine (Tabex) for smoking cessation

OBJECTIVES

Cytisine (Tabex) has been licensed in Eastern Europe as an aid to smoking cessation for 40 years. Cytisine is a partial agonist with high affinity binding to the alpha4beta2 nicotinic acetylcholine receptor believed to be central to the rewarding effect of nicotine. There is insufficient information on effectiveness to warrant licensing by modern standards. To assess whether full-scale controlled trials are warranted, this study sought to obtain an estimate of the 12-month continuous abstinence rates of smokers using cytisine with minimal behavioural support.

DESIGN

An uncontrolled, open-label trial.

SETTING

A smokers' clinic in an oncology centre in Warsaw, Poland.

SUBJECTS

436 consecutive attendees of the smokers' clinic of whom 191 were male. The mean dependence score (Fagerstrom Test for Nicotine Dependence) was 6.1.

INTERVENTION

The standard regimen of Tabex (cytisine) was used, involving 25 days of treatment with minimal behavioural support.

MAIN OUTCOME MEASURE

Self-reported continuous abstinence for 12 months; with abstinence verified by carbon monoxide at the final follow up (after 12 months).

RESULTS

60 participants (13.8% of the total sample) were abstinent for 12 months. Of the 315 subjects, who had taken the drug, 49 (15.5%) stopped cytisine because of adverse effects (mostly gastric disturbances and nausea), although they were not serious. The frequency of the minor adverse effects, primarily gastric disturbance, was similar to that observed in previous studies with the drug.

CONCLUSIONS

The long-term abstinence rates were similar to those observed in smokers receiving nicotine replacement therapy. Full-scale randomised trials of cytisine (Tabex), conducted to the standards required by regulatory authorities, are warranted.

Risk assessment of ritual use of oral dimethyltryptamine (DMT) and harmala alkaloids

AIM

To extend previous reviews by assessing the acute systemic toxicity and psychological hazards of a dimethyltryptamine and beta-carboline brew (ayahuasca/hoasca) used in religious ceremonies.

METHOD

A systematic literature search, supplemented by interviews with ceremony participants.

RESULTS

No laboratory animal models were located that tested the acute toxicity or the abuse potential of ayahuasca. Separate animal studies of the median lethal dose of dimethyltryptamine (DMT) and of several harmala alkaloids indicated that a lethal dose of these substances in humans is probably greater than 20 times the typical ceremonial dose. Adverse health effects may occur from casual use of ayahuasca, particularly when serotonergic substances are used in conjunction. DMT is capable of inducing aversive psychological reactions or transient psychotic episodes that resolve spontaneously in a few hours. There was no evidence that ayahuasca has substantial or persistent abuse potential. Long-term psychological benefits have been documented when ayahuasca is used in a well-established social context.

CONCLUSION

A decoction of DMT and harmala alkaloids used in religious ceremonies has a safety margin comparable to codeine, mescaline or methadone. The dependence potential of oral DMT and the risk of sustained psychological disturbance are minimal.